
        <table class="vertical_table" id='t_external_ocular_exam'>
            <caption>External Ocular Exam (Treatment eye only)</caption>
            <thead>
                <tr>
                    <th colspan="3"><?php echo xl('Eyelids'); ?></th>
                </tr>
				<tr>
                    <th colspan="3"><?php echo xl('Eyelashes'); ?></th>
                </tr>
				<tr>
                    <th colspan="3"><?php echo xl('Conjunctiva'); ?></th>
                </tr>
				<tr>
                    <th colspan="3"><?php echo xl('Sclera'); ?></th>
                </tr>
            </thead>
			<tbody>
				<tr>
					<td><select type='text' id='1_extocular_1' name='1_extocular_1'>
						<option value='1' text='<?php echo xl('Normal')?>'>
							<?php echo xl('Normal')?>
						</option>
						<option value='2' text='<?php echo xl('Abnormal')?>'>
							<?php echo xl('Abnormal')?>
						</option>
					</select></td>				
				</tr>
				<tr>
					<td><select type='text' id='1_extocular_2' name='1_extocular_2'>
						<option value='1' text='<?php echo xl('Normal')?>'>
							<?php echo xl('Normal')?>
						</option>
						<option value='2' text='<?php echo xl('Abnormal')?>'>
							<?php echo xl('Abnormal')?>
						</option>
					</select></td>				
				</tr>
				<tr>
					<td><select type='text' id='1_extocular_3' name='1_extocular_3'>
						<option value='1' text='<?php echo xl('Normal')?>'>
							<?php echo xl('Normal')?>
						</option>
						<option value='2' text='<?php echo xl('Abnormal')?>'>
							<?php echo xl('Abnormal')?>
						</option>
					</select></td>				
				</tr>
				<tr>
					<td><select type='text' id='1_extocular_4' name='1_extocular_4'>
						<option value='1' text='<?php echo xl('Normal')?>'>
							<?php echo xl('Normal')?>
						</option>
						<option value='2' text='<?php echo xl('Abnormal')?>'>
							<?php echo xl('Abnormal')?>
						</option>
					</select></td>				
				</tr>
            </tbody>
        </table>